Mind the gap!

The Third SSNAP Annual Report

Case Studies: Impact of effective psychological treatment after stroke

This case study was submitted by Dr Geoff Hill, Clinical Psychologist in Neuropsychology at South Tees Hospitals NHS Foundation Trust

Specialist Neuropsychology Support after stroke
Andrew was 52 when he had his stroke. He had a number of medical problems including diabetes and arthritis and was also struggling with the loss of his parents and the memories of childhood trauma before the stroke. He was referred by the Stroke Coordinator following his 6 month assessment to the Stroke Neuropsychology team at his local hospital, because of major concerns about his low mood. Andrew said that he felt completely unable to cope since the stroke and had been heavily relying on drinking to block out his emotional pain. Often having suicidal thoughts, he said that if anything further happened to his health he would end his own life. He was very tearful, and felt hopeless.
He was able to engage well with the neuropsychologist to help him understand his distress, and then started on a course of talking therapy. This focused on helping him to explore new, more flexible ways of coping using techniques such as mindfulness. This also supported him to live a richer and healthier life such as eating better, taking regular exercise, starting up his hobbies again, and spending more time with his family and friends.
He quite quickly reported less depression and anxiety, no longer had suicidal thoughts, and was beginning to enjoy life again. He was discharged after 4 months of treatment showing how specialist neuropsychology support can make an enormous difference to peoples’ lives.

This case study was submitted by Dr Naomi Hynd, Specialist Clinical Psychologist in Neuropsychology at South Tees Hospitals NHS Trust

Acceptance and Commitment Therapy Groups for Stroke Patients

Developing a rolling programme of different therapy groups has proved highly successful. The ACT group has been particularly well received. Up to 10 patients can attend and the group runs for 6 weeks. It involves a mixture of didactic presentation, exercises, videos, individual and paired work and group reflection. Attendance has been consistently high. It incorporates Mindfulness exercises which are given as intensive daily homework. The content helps patients to develop self-efficacy and respond to their current circumstances in new ways. Exercises such as “Walking in the Rain” and “The Bus” encourage patients to visualise their difficulties in different ways, challenging fixed and unhelpful thoughts or patterns of behaviour while enabling new and creative solutions to develop. Reflecting on suffering is never easy, however the ACT group discusses the topic in a sensitive and supportive way. The material helps patients to understand the role they play in continuing (and even increasing) their suffering. The group discusses ways of changing how they relate to suffering and engenders skills to manage more effectively. The emphasis on values is particularly important and helps patients to reengage with meaningful activities and feelings of self-worth and purpose. It encourages re-engagement with the world outside of stroke rehabilitation particularly in terms of strengthening relationships and pursuing new life goals. In the last session patients briefly note down the positive attributes of the other group members. This task helps to reaffirm individual strengths while facilitating self-acceptance and confidence.
End of group assessment indicates clinically significant improvements in mood have occurred. Three month follow up shows that attendees continue to explore and developed new interests as well as widen their social network. Self-esteem and general well-being are rated as high.

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